IMMUNOHISTOPATHOLOGIC TESTING IN PATIENTS SUSPECTED OF OCULAR CICATRICIAL PEMPHIGOID

Purpose. Optimizing the sensitivity of immunopathologic methods in det ecting tar get antigens in immune-mediated cicatrizing conjunctivitis. Methods. Immunofluorescence was performed on normal and salt-split co njunctival biopsies in fifteen patients with clinical evidence of ocul ar cicatricial pemphigoid, and results were compared with immunoperoxi dase, a technique thought to be more sensitive although more expensive and more difficult technically to perform. Results. Ten of fifteen bi opsies (67%) were positive when conventional and salt-split immunofluo rescence results were combined. Four of eight patients with positive c onventional immunofluorescence showed more marked immunofluorescence w ith the salt-split method. All patients were positive with immunoperox idase(100%). Conclusion. Immunoperoxidase was more sensitive than conv entional or salt-split immunofluorescence in detecting immunoreactant deposition along the basement membrane of the conjunctiva. Salt-split immunofluorescence demonstrated more intense staining of conjunctival samples when compared with conventional immunofluorescence, without ho wever increasing the yield of positive biopsies. Finding solutions for the proper handling of conjunctival tissue in salt may improve the di agnostic yield of salt-split immunofluorescence.